This blog is a commentary on contemporary business, politics, economics, society, and culture, based on the values of Reason, Rational Self-Interest, and Laissez-Faire Capitalism. Its intellectual foundations are Ayn Rand's philosophy of Objectivism and the theory of the Austrian and British Classical schools of economics as expressed in the writings of Mises, Böhm-Bawerk, Menger, Ricardo, Smith, James and John Stuart Mill, Bastiat, and Hazlitt, and in my own writings.

Saturday, August 08, 2009

Replies to Readers of My Article on the Real Right to Medical Care

From a reader in Cambridge, ON, Canada:RE:The Real Right To Medical Care....

[T]hanks for the fantastic article on real medical care vs. socializedmedicine. I am writing this email because I am a young Canadian who has a socialized medical system. While I cannot argue your logic for a true free market medical care system, I did finish your piece feeling like there is one hole. Not to say the idea is flawed, by no means, but if individuals have a right to life, and had an illness that was fatal if not treated but could not afford said treatment, where does that leave doctors? You mention charity, and I'm sure to a degree that would exist, but if you were a practicing medical doctor, and knew you could save a life with a simple procedure, how many could you turn away based on cost? While I wholeheartedly agree with the principles you outline in your piece, I found it fascinating, I did get the sense that the issue was not broached for that reason. Now I realize this may only be a small percentage of the population in a truly free market, but a life is a life at the end of the day. I hope you find the time for at least a modest response, if I somehow missed you stating said circumstance in your piece, please simply direct me to said section.

Dear Reader:Thank you for your note. The right to life is not a right to be kept alive by other people, against their will. If there were such a right, then you and I and everyone else not in poverty would have to be devoting our lives to keeping alive countless numbers of impoverished people all over the world. To the contrary, paraphrasing Ayn Rand, the right to life is the right of an individual to take all of the [peaceful, non-coercive] actions that sustain and promote his life. This understanding of the right to life is incompatible with the notion of people having a right to be kept alive at others’ expense.

Of course, people may wish to give to charity within the limit of their perceiving that doing so enhances their own lives. The funds raised through charity together with the time doctors were willing to provide to charity patients would undoubtedly be concentrated on cases in which all that was necessary were relatively simple, inexpensive procedures that would save life or limb. But this cannot be a solution for all those medical problems requiring more complex and costly treatments that are beyond the means of patients and of the willingness and ability of people to provide charity.

What the solution for these medical problems is, is economic progress, which continuously improves medical care and makes it less and less expensive, while at the same times making practically all other goods and services better and less expensive as well, thereby freeing up more income to be spent on medical care if necessary. The foundation of economic progress, of course, is individual freedom and capitalism.Always, however, there will be some people who will die because still more and better care, that others might have provided, was beyond their reach. There is simply no way to avoid this. It’s an aspect of the fact that man is mortal.

Trying to avoid it by compelling everyone to devote his life to keeping other people alive, beyond his perception of the personal, value to his own life of doing so, destroys the incentives to produce and advance, and thus ultimately does no good to anyone.

Because of this destruction, attempts to enforce such an obligation always stop short after a time. In fact, this is what we are seeing right now in the United States in the proposed roll backs in Medicare and denial of treatment to the elderly. It’s what already has taken place in Great Britain, and, I believe, in Canada and everywhere else that medical care has been collectivized long enough.

The government simply lacks the means to provide everyone with unlimited medical care. Eventually, it has to impose limits. But its limits entail depriving people of medical care who could have afforded it, if left free to use their own resources for that purpose. Its limits entail aborting further progress in medical in order to hold down the cost of operating its collectivized system.

There are two sorts of limits to medical care. One is reality, which encompasses the state of scientific and technological knowledge, the state of capital accumulation, the resulting productivity of labor, and the relative performance of different individuals cooperating together under economic competition and the pursuit of individual self-interest. Under capitalism, as the result of the pursuit of self-interest and competition, this limit is continually pushed outward and the level of care for everyone continually improves. (See my book Capitalism, chap. 9, for further discussion of this.)

The other kind of limit to medical care is arbitrary government fiat. The government takes over medical care and it decides who is to receive care and to what extent. Under government control, the limit to medical care tends to be frozen, indeed, declining. Progress in medical care is largely prohibited as a threat to the government’s budget and decline accompanies the coming to the fore of doctors who are content to be mere tools of government policy; it also accompanies the general economic decline that results from related government policies that are hostile to capital accumulation and economic efficiency.There’s undoubted more to be said. But I hope that these remarks serve to address the matters you raised.

Sincerely,George Reisman

From a reader in Perth, Western AustraliaSubject: stupid Samaritan patsy

"It should be obvious that such an arrangement entails the utter perversion of the right to medical care."

Dear Dr Reisman,

I find it astounding that a man who can write some many thousands of words on a topic, in apparently grammatically good English, can have the whole concept so wrong.Altruism, empathy - those are the core concepts of society, not the market place. Health care is part of the altruistic nature of society, and it arose not out of purely commercial needs, it arose because most people on this planet have empathy for those who are sick, those who are unwell. People form collective societies for exactly that reason, to share the common burdens and chance misfortunes in life equally and fairly between those can and those who can't afford it.

I assume you are basically an anarchist with your attitude. All people are free from obligations to any other person, no matter what their circumstances. Hence the idea of Government to provide common services is unnecessary. I guess you probably believe that education should also be a purely commercial domain as well.

It scares me that you may have been teaching these attitudes to your economics students, the world is a poorer place if you have done so. Did you ever lecture or write on the economics of altruism or is it so far away from your moral centre that you can't understand the concept?

You are one of the people who left the man in the ditch for the stupid Samaritan patsy to come along and waste his good economic resources of food, water and labour on the man who for no reason of his own was in dire needs.

Your attitude may seem intellectually clever, put it is morally poor.

As a contrast, here in Australia we have fine collective system of medical care that works extremely well for the citizens of Australia. It is affordable, and we have better health care than the USA.

So, Dr Reisman, I think you need to look at the poor, the unemployed, those born with impediments such as lower intelligence, mental or physical disabilities and try to apply your huge mind to putting yourself into their position. It is probably difficult for you to do so, but should you be successful, you will hopefully feel remorse for your shockingly selfish position on health care.

Dear Reader:

Altruism is a philosophy of misery, suffering, poverty, and the hatred of man for man. It is the philosophy that ruled the Dark Ages and underlay such accompaniments as the Iron Maiden, the rack, and burning people alive at the stake.

Civilization is founded on the philosophy of egoism and recognition of the individual's right to the pursuit of his own, selfish happiness and the corollary recognition that the means of accomplishing this is voluntary, peaceful social cooperation under the division of labor. The gains from the division of labor give to each individual a rational self-interest in the existence of other people and in their individual freedom and right to the pursuit of their own happiness. This is the arrangement that progressively increases the supply of goods and services and improves life for everyone. (For elaboration, see Ludwig von Mises's Socialism and my Capitalism.)

Under this arrangement—i.e., capitalism—the individual comes to regard other people with benevolence, because their existence improves his existence. In such conditions, people are prepared, within limits, to help others who suffer through no fault of their own. Thus, they help victims of earthquakes, floods, and all other natural disasters. They help people who cannot help themselves, including those who are stuck in a ditch. But that is not their primary goal or, as a rule, a major goal. It is secondary and rests upon their pursuit of their own happiness.

In contrast, when altruism prevails, each individual must regard all other individuals as a source of loss and misery. Their existence is a constant claim against his wealth and time and thus against his ability to enjoy his life. In such circumstances, the individual easily reaches the conclusion that he would be better off if those others did not exist. He would then be free of the burdens they impose.

Historically, the United States was characterized by the individual’s freedom to pursue his own happiness (a basic right enumerated in our Declaration of Independence). Thus, not surprisingly, it was also known for the goodwill and benevolence of its citizens. In contrast, the Dark Ages and the Soviet Union, two leading exemplars of altruism, were known for their hatred and barbaric treatment of human beings. What results from the prevalence of altruism is conveyed in a widely told story in the Soviet Union. It was the story of the Russian who is asked by God to wish for something that he would like God to do for him, on the understanding that whatever God does for him, he will do twice as much for his neighbor. After hearing this offer, the Russian asks that God pluck out one of his eyes, so that his neighbor can lose both eyes. (The story was reported by Hedrick Smith, in his book The New Russians, New York: Random House, 1990, p. 204.)

So much for altruism.

George Reisman

P. S. For elaboration on the contrasting natures of egoism and altruism, see the writings of Ayn Rand, in particular, Atlas Shrugged and The Virtue of Selfishness. P.P.S. Concerning education, I believe that it should be stricly private. Schools would be legally free to operate on a commercial or non-commercial basis, as they chose. Individual would be free to support non-commercial schools and to provide scholarships for students attending for-profit schools. The main thing is that the government should not be allowed to attempt to improve students' minds on a foundation of pointing a gun at anyone's head, such as unwilling taxpayers, unwilling parents, and unwilling students.Finally, I am not an anarchist but a supporter of government that is limited to the defense of the rights of the individual against the initiation of physical force, including fraud.